Drug Complications Common Among Outpatients

March 2000 Journal of General Internal Medicine

A recent study of outpatients taking prescription drugs indicates that drug complications among outpatients appear to be more common than medical records reflect.

These complications may be long lasting and have additional negative consequences, including patient dissatisfaction with care and more use of the health care system. Outpatients also reported worry, discomfort, and interference with daily activities resulting from drug complications.

"Physicians often take these types of reactions for granted in the course of medical therapy. However, it is important to realize that these events are not minor to patients. Physicians may underestimate the impact of these events on patient satisfaction, health care utilization, and quality of life," said lead author David Bates, MD, MSc, of Brigham and Women¹s Hospital in Boston, MA.

Outpatient drug complications are generally believed to be commonplace; in fact, a previous study suggested that more than one million outpatients in the United States experienced a drug complication requiring hospital admission in 1994. But these complications have not been well studied and are difficult to monitor for several reasons, according to Bates.

"In contrast to inpatients, outpatients are responsible for both obtaining and administering their medications. Therefore, the process is much less controlled. Also, physicians have less regular contact with outpatients and are less likely to hear about their problems," said Bates.

Of the 2,248 outpatients taking prescription drugs who were surveyed in this study, 394 reported experiencing a drug complication. However, only 64 drug complication events were recorded on medical charts, the researchers found. Bates and colleagues from Brigham and Women's Hospital and from San Francisco General Hospital, CA, published their findings in the March 2000 issue of the Journal of General Internal Medicine.

The drugs most commonly involved in patient-reported complications were antibiotics, antidepressants, and nonsteroidal anti-inflammatory drugs. The most common side effects were gastrointestinal ailments, sleep disruptions, mood changes, and tiredness.

Many outpatient drug complications are probably preventable, according to Bates and colleagues. Computerized prescribing systems can be used to detect allergies and drug-drug interactions, for example. A reduction in the prescription of antibiotics, which are often prescribed unnecessarily, may also help.

Also, physicians need to better explain side effects to patients before treatment. The view held by some physicians‹ that patients are more likely to experience side effects if they are informed about them‹ is erroneous, according to Bates. "Patients who know in advance about potential side effects may handle them better or have less concern about them," he said.

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